Individual
GERACI MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBSW, MHA, CHAPLAIN
Contact information
Practice address
408 W UPSHUR AVE, GLADEWATER, TX 75647-2124
(903) 918-8152
Mailing address
408 W UPSHUR AVE, GLADEWATER, TX 75647-2124
(903) 918-8152
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
TX
101YM0800X
Mental Health Counselor
—
TX
101YP1600X
Pastoral Counselor
—
TX
104100000X
Social Worker
26197
TX
251K00000X
Public Health or Welfare Agency
Primary
—
TX
251S00000X
Community/Behavioral Health Agency
—
TX
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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